Sexual side effects of antidepressant medications are far more common than initially reported, and their scope, quality, and duration remain poorly captured in the literature. Antidepressant treatment emergent sexual dysfunctions may decrease clients’ quality of life, complicate psychotherapy, and damage the treatment alliance. Potential damage to the treatment alliance is greatest when clients have not been adequately informed of risks related to sexual side effects. It had previously been assumed that sexual side effects always resolve shortly after medications are discontinued. Emerging evidence, however, suggests that in some individuals, sexual dysfunction side effects may persist indefinitely. The authors argue that all psychologists should be well-informed about sexual side effects risks of antidepressant medications, should routinely conduct a pre-medication baseline assessment of sexual functioning, and take an active role in the informed consent process.

Sir: It is widely known that selective serotonin reuptake inhibitors (SSRIs) can cause various types of sexual dysfunction (SD) and recent studies have shown that prevalence may be as high as 60%1 among SSRI users. Emerging evidence shows that in some patients SD may persist and even worsen, long after treatment cessation. It is this group of long-term post-SSRI treatment sufferers that we are concerned with here....

Sexual dysfunctions such as low libido, anorgasmia, genital anesthesia, and erectile dysfunction are very common in patients taking selective serotonin reuptake inhibitors (SSRIs). It has been assumed that these side effects always resolve after discontinuing treatment, but recently, four cases were presented in which sexual function did not return to baseline. Here, we describe three more cases. Case #1: A 29-year-old with apparently permanent erectile dysfunction after taking fluoxetine 20 mg once daily for a 4-month period in 1996. Case #2: A 44-year-old male with persistent loss of libido, genital anesthesia, ejaculatory anhedonia, and erectile dysfunction after taking 20-mg once daily citalopram for 18 months. Case #3: A 28-year-old male with persistent loss of libido, genital anesthesia, and ejaculatory anhedonia since taking several different SSRIs over a 2-year period from 2003-2005.

RESULTS:

No psychological issues related to sexuality were found in any of the three cases, and all common causes of sexual dysfunction such as decreased testosterone, increased prolactin or diabetes were ruled out. Erectile capacity is temporarily restored for Case #1 with injectable alprostadil, and for Case #2 with oral sildenafil, but their other symptoms remain. Case #3 has had some reversal of symptoms with extended-release methylphenidate, although it is not yet known if these prosexual effects will persist when the drug is discontinued.

CONCLUSION:

SSRIs can cause long-term effects on all aspects of the sexual response cycle that may persist after they are discontinued. Mechanistic hypotheses including persistent endocrine and epigenetic gene expression alterations were briefly discussed.

Abstract from the paper: SSRI therapy is commonly associated with sexual side effects, but it is assumed that these distressing symptoms resolve with termination of therapy. The atypical antidepressant nefazodone is infrequently associated with sexual dysfunction and may be substituted for SSRI’s when sexual symptoms are intolerable. Recently, scattered case reports of persistent sexual dysfunction and genital anesthesia persisting well after termination of SSRI antidepressant therapy have surfaced. In each case, the underlying depressive disorder was in remission.

Case: A 32-year old women with major depression was treated with citalopram but switched to nefazodone after 4 weeks of therapy due to genital anesthesia and orgasmic dysfunction. These symptoms continued following institution of nefazodone therapy and have persisted for over a year since termination of antidepressant treatment. Her depression remains in full remission.

Discussion: It is likely that persistent post-treatment genital anesthesia and other sexual side effects are underreported, and physicians should be aware of this bothersome phenomenon. Formal post-treatment surveillance for this condition is war- ranted. Pharmacogenomic research may ultimately allow physicians to predict who is at risk for antidepressant induced sexual side effects.

Post-market research has now firmly established that the SSRIs and SNRIs can significantly affect most every aspect of sexual functioning at rates significantly higher than the 5-15% reported in pre-market trials. Depending on definitions of sexual dysfunction and methodology, post-market prevalence studies have found rates between 36% and 98%. The 5 to 15% rates of SSRI and SNRI-induced sexual side-effects listed in the current drug-insert literature are based on information obtained in the initial trials via spontaneous reports of individuals who had been on the medications for a short time. The differences in reported rates between the pre-market trials and post-market prevalence studies are an artifact of methodology; we now know that when individuals are directly asked about their experience of sexual side effects via either a structured clinical interview or a self-report inventory, we obtain vastly different rate information than if we rely on individuals to spontaneously volunteer personally sensitive information about changes in sexual functioning....

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btdt

btdt

As the above showed high prolactin was not the cause of PSSD why would they use Cabergoline as a preventative... I wonder does it work would it help me. Do you have any further understanding or information on this?

It has at times been used as an adjunct to SSRI antidepressants as there is some evidence that it counteracts certain side effects of those drugs, such as reduced libido and anorgasmia. It also has been suggested online that it has a possible recreational use in reducing or eliminating the male refractory period, thereby allowing men to experience multiple ejaculatory orgasms in rapid succession, and at least one scientific study supports those speculations.[7] It is also used by bodybuilders to control gynecomastia caused by elevated prolactin levels through the use of anabolic steroids such as nandrolone and trenbolone. Additionally, a systematic review and meta-analysis concluded that prophylactic treatment with cabergoline reduces the incidence, but not the severity, of ovarian hyperstimulation syndrome (OHSS), without compromising pregnancy outcomes, in females undergoing stimulated cycles of in vitro fertilization (IVF).[8] Also, a study on rats found that cabergoline reduces voluntary alcohol consumption, possibly by increasing GDNF expression in the ventral tegmental area.[9"

I have always said I will not take drugs I do not understand seven years of PSSD has me asking questions about this one just asking.

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Altostrata

Altostrata

Occasionally someone on SSRIsex posts that they've tried cabergoline. Success seems to vary or they'd all be taking it!

It seems that males are the focus of the Wikipedia statement. Men seem to be more driven to try anything to increase virility. I've never heard of women taking it. Obviously, whatever hormonal effects it has would be different in women.

The relevance of testosterone, oestradiol and certain peptides (oxytocin (OT), beta-endorphin and prolactin (PRL)) to sexual arousal in humans is reviewed. In addition to behavioural studies, evidence of distribution of gonadal steroid receptors in the brain and the limited evidence from brain imaging are also considered. Testosterone plays a key role in the adult male, with clear, consistent evidence from studies of hypogonadal and eugonadal men. The roles of testosterone in the development of sexual arousability, and in the aging male, are less clear. The relevance of aromatization and of non-sexual effects of testosterone which might indirectly influence sexual arousal are not well understood. Testosterone in the female presents a more complex, less consistent picture. One possible explanation is a much greater variability across women in responsiveness to testosterone. A 'desensitization hypothesis' to account for the striking gender differences is offered. There is limited evidence of a direct effect of oestradiol on sexual arousability in women. The extent to which testosterone in women acts by conversion to oestradiol or by increase of free oestradiol is not yet clear. The role of peptides in sexual arousal remains uncertain, partly because of the multiple roles and sites of action of most peptides. OT and beta-endorphin appear to have both excitatory and inhibitory effects. PRL has been proposed as an inhibitory factor via direct inhibition of dopaminergic activity, but the evidence for this is inconclusive. Whereas the traditional concept of 'hormone' continues to apply to the role of testosterone and oestradiol in sexual arousal, peptides present a more complex role.

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zenzeno

zenzeno

I'll see if I can get a hold of the authors. If the conclusion to their paper is any indication, I'm guessing any potential update from either of them will be just as ambiguous: "Long term follow up will be crucial in order to determine if antidepressant induced sexual dysfunction remains a permanent phenomenon."

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crazykatie

crazykatie

I really haven't put much thought upon this bc I hate to think about it.

This year I finally researched to find why my libido was so decreased n why things that used to feel good sexually started hurting me. I knew it was the meds. Well this year, I was resolved to find another answer. We got my low estrogen boosted to average range. I got my prolactin level to normal again. So I have to accept its these meds.

I don't know if anyone else can relate, but I almost feel asexual. Sex is a chore to me. I just lay there hoping it will be over quick. Is this normal?

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forexworld12

forexworld12

I really haven't put much thought upon this bc I hate to think about it.

This year I finally researched to find why my libido was so decreased n why things that used to feel good sexually started hurting me. I knew it was the meds. Well this year, I was resolved to find another answer. We got my low estrogen boosted to average range. I got my prolactin level to normal again. So I have to accept its these meds.

I don't know if anyone else can relate, but I almost feel asexual. Sex is a chore to me. I just lay there hoping it will be over quick. Is this normal?

you were on some 10 drugs or more ....I am sure wellbutrin didn't work for pssd .it wont alone anyway ...but here is a thing You want to get off all the drugs and everything - turn the lifestyle around , go to gym ..strict diet , protein rich diet .. and take a few supplements that are all mentioned over here .. this may take a few years but it is the best shot for recovering naturally ! some were saying about inositol treats symptoms of PSSD and that is true because of the upregulation mechanism http://www.ncbi.nlm.nih.gov/pubmed/11267629

You were on trazodone but with combination of other medication ... I would strongly advice to get off all medication esp SSRI- they are the most toxic

Trazodone alone is an interesting compound that can reverse some symptoms of PSSD .. Trazodone is an alpha-1-adrenergic blocker - which means it almost entirely blocks the vasoconstrictive effects of adrenaline.Trazodone antagonizes the contractile serotonin receptors...That would be 5-HT2A etc .Trazodone may thus lower cortisol and prolactin levels and raise testosterone indirectly.

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nz11

nz11

I have given up any hope of an improvement in this area ..after 4 years drug free and waiting for a recovery that hasnt occured i now see it as permanent ..thats right i said the p word ...its permanent damage done by one proclaiming first to do no harm....yeah right!

Yes i also feel asexual. The nerves in this area imo have somehow been chemically destroyed imo.

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btdt

btdt

It was more for interests sake even tho I use to like sex I think hard to recall... but I think I had some amazing moments ...

I don't know what it's worth is to me at this point in my life perhaps I have lived so long without it now I have settled...

maybe if I had an urge and couldn't I would feel different.. yes I do think of it I know it is off the table... so try not to hamper myself more with thoughts of sex

If it all came back due to natural healing I would welcome it with open arms... I like to feel as human as possible as alive as possible. however... I am in no way ever going to consider this option they are using in rats...

not ever... or any other drug either... in the beginning I thought of trying this or that to treat it looked long and hard for a "cure" maybe I recalled sex better then I felt the need to fix a lot more then... I hate the thought that I have just given up on it.. I hate the thought I have just settled but maybe I have I just don't know. I do know I am not willing to risk any of the hard won healing I have so far to get sex back not a chance in hell.

I don't think anyone can guarantee the results of drugs on a person like me as I now react to most things I take enough I would never chance a drug to get sex back into my life... I don't trust the drugs to be safe... sorry once bitten twice shy.

LOL this thought comes to mind... the three stooges... hit on the head gets amnesia and of course another hit on head cures him... we know what serial concussions do to sports players don't we. I am just running off at the mouth here and this is just me... we are all different so I hear.

There have been reports for over a decade linking serotonin reuptake inhibitors, finasteride and isotretinoin with enduring sexual dysfunction after treatment stops.

OBJECTIVE:

To explore the clinical pictures linked to all 3 drugs.

METHODS:

We have selected 120 reports to RxISK.org reporting the problem and mined these for data on age, gender, drug of use, and impact of the problem.

RESULTS:

The data make it clear that the three drugs show extensive overlap in symptom profile, regardless of sex or country of origin.

CONCLUSIONS:

The availability of 120 reports from over 20 countries add to the case for the validity of the syndrome. This is severe and enduring condition can result in death. An understanding of its physiology and an approach to treatment are needed.

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btdt

btdt

I really haven't put much thought upon this bc I hate to think about it.

This year I finally researched to find why my libido was so decreased n why things that used to feel good sexually started hurting me. I knew it was the meds. Well this year, I was resolved to find another answer. We got my low estrogen boosted to average range. I got my prolactin level to normal again. So I have to accept its these meds.

I don't know if anyone else can relate, but I almost feel asexual. Sex is a chore to me. I just lay there hoping it will be over quick. Is this normal?

you were on some 10 drugs or more ....I am sure wellbutrin didn't work for pssd .it wont alone anyway ...but here is a thing You want to get off all the drugs and everything - turn the lifestyle around , go to gym ..strict diet , protein rich diet .. and take a few supplements that are all mentioned over here .. this may take a few years but it is the best shot for recovering naturally ! some were saying about inositol treats symptoms of PSSD and that is true because of the upregulation mechanism http://www.ncbi.nlm.nih.gov/pubmed/11267629

You were on trazodone but with combination of other medication ... I would strongly advice to get off all medication esp SSRI- they are the most toxic

Trazodone alone is an interesting compound that can reverse some symptoms of PSSD .. Trazodone is an alpha-1-adrenergic blocker - which means it almost entirely blocks the vasoconstrictive effects of adrenaline.Trazodone antagonizes the contractile serotonin receptors...That would be 5-HT2A etc .Trazodone may thus lower cortisol and prolactin levels and raise testosterone indirectly.

"Trazodone alone is an interesting compound that can reverse some symptoms of PSSD .. Trazodone is an alpha-1-adrenergic blocker - which means it almost entirely blocks the vasoconstrictive effects of adrenaline.Trazodone antagonizes the contractile serotonin receptors...That would be 5-HT2A etc .Trazodone may thus lower cortisol and prolactin levels and raise testosterone indirectly."

Apr 2, 2011 - In a study of twins, the one taking any class of antidepressant had a 5% ... serotonin-reuptake inhibitors (SSRIs), can cause vasoconstriction of various ... the observational nature of the analysis, noting that these results do not ...

If another drug helped I would not take it not a psych drug like this... I was going to look but came to a site already talking about it

"It is hypothesized that SSRI treatment induces disturbances of transient receptor potential (TRP) ion channels of mechano-, thermo- and chemosensitive nerve endings and receptors resulting in the penile anesthesia in PSSD. It is further hypothesized that there are two types of PSSD, one of which occurs soon after the start of SSRI treatment."

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btdt

btdt

More research on the ion channels may show something it is not like anyone is really trying to fix this... I don't think it is a real big push... I wish it were. Something is wrong we know that sex is gone I know that... getting it back online is a process for some but after all this time and the wild headaches I get ...more like my brain is going to explode approaching orgasm... well that pain is not worth it. Something is still wrong. Some people just get better for me it did not happen. Not yet at any rate and they say the only emotion greater than fear is hope... so if you can keep some hope maybe it will be helpful.

Not so sure I can muster hope myself but still suggest it as a better way to live in withdrawal then the alternative... again is kind of like a choice but not really a real choice ... if that makes any sense.